Assessing the public health implications of Brexit in Wales: a health impact assessment

Abstract

BackgroundIn June 2016, the UK voted to leave the European Union (EU) in a process known as Brexit, which is surrounded by political and social uncertainty. We aimed to assess the potential impact of Brexit on Wales. MethodsUsing health impact assessment methodology steered by a Strategic Advisory Group, we did a comprehensive mixed-method health impact assessment between July 2, 2018, and Jan 21, 2019. We searched MEDLINE, Embase, and Proquest databases using the well-established PICO (population, intervention, comparator, and outcome) framework used in evidence-based practice to frame and answer a health-care related question, to identify peer-reviewed literature published after January 2016, on the potential impact of Brexit on health and the economy. We supplemented the search with a review of grey literature on direct impacts, such as the environment, health care, and EU funding. Additionally, we held a stakeholder workshop including cross-sectoral representation such as housing, environmental health and planning, qualitative interviews with policy leads, and developed a community health profile using recognised data sources (eg, the National Survey for Wales) to understand the different population groups. The findings were analysed, synthesized, and collated into a published report. FindingsThe health impact assessment identified considerable potential impacts across the wider determinants of health, including effects across vulnerable population groups, mental wellbeing, and geographical areas in Wales that receive EU funding. Trade agreements, changing relationships with EU agencies, uncertainty, and loss of regulatory alignment were identified as key pathways for health impacts. For example, trade agreements can improve the supply and choice of food, but can also result in trade liberalisation and increased imports of highly-processed foods. Another example is the impact on food safety due to workforce challenges (ie, the low number of certificating officers at abattoirs who are UK-national citizens). InterpretationSince Brexit is yet to occur, the impacts identified are potential. Although this assessment was done over a short period of time, the findings have been beneficial in informing decision makers to prepare for Brexit using an evidence-informed approach. This work highlights the value of a health impact assessment approach to unprecedented events by mobilising a wide range of evidence through a transparent process, resulting in transferrable learning for others. FundingPublic Health Wales.